Jonathan M. Sykes and Amir Allak

Summary

This chapter discusses the role of technology in facial plastic surgery. We will analyze the methods and influences that affect physician and patient choices and discuss the role of industry and the Internet in educating and biasing patients. We will also consider the many factors that influence every practitioner, such as economics, ego, industry advertising, and skill level.

Keywords: adipocytolysis, advertising, biases, cryolipolysis, decision-making, deoxycholic acid, direct-to-consumer advertising (DTCA), facial analysis, hair restoration, laser technology, lipolysis, liposuction, online marketing, patient expectations, push marketing, social media, technology, ultrasonic energy therapy

Key Points

Each time that a facial plastic surgery patient requests alteration in facial appearance and/or function, the practitioner faces a decision-making process that includes several factors: the wants and desires of the patient, the facial analysis, the psychological composition of the patient, and the inherent biases and skills of the surgeon.

Of course, the specific requests of an individual patient are of paramount importance in shaping the discussion regarding procedure choice. The change (s) that the patient is seeking should always be the most important factor in deciding which recommendations to make. After considering the patient’s goals, the surgeon should then discuss the therapeutic treatment options. This dialogue is important in educating and empowering each patient. The communication that occurs during the initial consultation plays a significant role in determining whether the patient’s expectations can be met and if the procedures suggested will accomplish the patient’s desires. This process is as important a factor in determining patient satisfaction as is the performance of the procedure itself.

The best therapeutic option for any patient may be a single procedure or a combination of procedures and technologies. The practitioner’s individual skill, comfort level, and personal bias influence what procedure (s) is recommended. It is the duty of each practitioner to use the best evidence regarding any procedure or technology before suggesting this to any patient. It is only after being presented this evidence that the patient can make an informed choice on any given procedure.

This chapter will discuss the role of technology in facial plastic surgery. Specifically, the methods and influences that affect physician and patient choices will be analyzed. The role of industry and the Internet in educating and biasing patients will also be discussed. Finally, the factors that influence every practitioner—economics, ego, industry advertising, and skill level—will be considered.

The Internet has been a vehicle to globalize facial plastic surgery. It has contributed to the increase in the frequency of procedures, has improved access to patient education, and has allowed plastic surgeons to advertise their skills and market their practices. Physicians realize that patients relish the ability to research their doctor and his or her practice. Patients often cannot discriminate between fact and fiction, and the information provided on the Internet is not monitored for reliability or accuracy.

Patients commonly request new procedures, products, or technologies. They often feel that what is new is desirable. To many patients, recently adopted procedures with marketed names afford an advantage over more established procedures and technologies. It is common for a plastic surgery patient to ask their practitioner, “Do you have anything new?” or “Are there any new techniques that you are using?” Patients are frequently persuaded by physicians who market their new or “special” technique, or by the industry that markets their product as “the best.” The combination of the patient wanting the “latest and greatest” and the physician wanting to sell their product and/or services often makes the patient prey to misleading predictions of outcomes.

Advertising and marketing is an important component of practice in plastic surgery. Individuals who practice any aspect of cosmetic medicine realize that success in their practice is related to their ability to advertise their products and to market their skills. Aesthetic surgery and related aesthetic services are “created wants,” not needs. Advertising makes patients aware of the services offered and is an avenue for physicians to educate the public about the credentials and experience of the physician. The Internet is also a tremendous vehicle to disseminate information and to describe new technologies and services.

Two main strategies exist in advertising aesthetic products and services: push and pull marketing campaigns. Each of these strategies is well suited for certain types of offerings provided by facial plastic surgeons and can also be inefficient and unproductive uses of valuable resources when applied in the wrong setting.

In pull marketing strategies, consumers who are already engaged in a relationship with the seller are given information about products during ongoing consultation. This is a more familiar archetype for facial plastic surgeons, because the discussion of options for facial rejuvenation often lends itself well to an introduction of new products or procedures. Examples include introducing a patient to a new facial filler or skin resurfacing device while weighing rejuvenative options. Because patients will often see not only the surgeon but also the aesthetician and clinic staff, it is imperative that all staff are aware of the new offerings and can introduce them when relevant. The penetrative exposure of pull marketing is low, but the yield is higher than with push marketing and it has the additive ability to foster trust and build the surgeon–patient relationship.

Medical device companies play an important role in plastic surgery practices. They fund technology that creates new devices, which expand the services provided to patients. Increasing technology positively impacts physicians’ practices, and can improve the overall aesthetic results for patients. Creating these new technologies requires funding that would not be possible without companies willing to raise capital in an effort to capitalize on these technologies.

Of course, the main goal of medical device companies is profit. The process for companies to create profit is to stimulate a new idea, to create and fund the technology, and then to market and sell it. Selling the technology involves marketing the device to the physician and direct-to-consumer advertising (DTCA).

In some ways, DTCA by industry can benefit the aesthetic surgery market and individual physician practices. However, it is common for drug and device companies to inflate the efficacy and downplay the safety issues related to their drug or device. Industry in medicine often gets a product FDA-approved and then markets the product without an adequate scientific basis. The model—the product, followed by marketing, then followed possibly by science—can be deceptive to the public. Physicians cannot rely on the statements of manufacturers to ensure the validity of claims often made by companies to sell products. It is the responsibility of the physician to not just repeat the manufacturer’s party line, but also to confirm the accuracy of their claims. This is done by carefully analyzing aesthetic outcomes and monitoring patient satisfaction from new devices and procedures.

For many years, the only means to reduce fat volume was with a surgical procedure. In the body, this required liposuction (with or without abdominoplasty or other body lift). In the neck, submental liposuction with or without neck lifting or facelifting was the only treatment. More recently, devices and injectable drugs that create lipolysis and tighten the soft tissues have been designed, giving the patient and practitioner alternatives to surgery (see Video 2.11).